Effects of Overweight and Obesity on Recruitment in the Military

Effects of Overweight and Obesity on Recruitment in the Military Tracey J. Smith, PhD, RD Military Nutrition Division U.S. Army Research Institute of Environmental Medicine Roundtable on Obesity Solutions 7 MAY 2018 UNCLASSIFIED //FOUO Slide 1 of 13

Disclaimer The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Army or the Department of Defense. Any citations of commercial organizations and trade names in this report do not constitute an official Department of the Army endorsement of approval of the products or services of these organizations. Slide 2 of 13

Outline Prevalence of overweight and obesity in militaryage U.S. civilians. Ineligibility of military applicants due to body weight and body fatness. Prevalence of enlistees that exceed Army weightfor-height guidelines and associated health risks. Recommendations for military recruitment. Slide 3 of 13

Introduction Obesity has been posited as a threat to national security. Negative health implications impact health costs. ~$1.5B annually in health care expenses and costs to replace unfit personnel due to obesity. Obesity = lost work days, degraded readiness, higher need for aeromedical evacuation and ineligibility in recruitment. 1. Voss et al. International Journal of Obesity, Obesity as a threat to national security: the need for precision engagement. Published online 9 March 2018. Slide 4 of 13

Overweight & Obesity in the U.S. Americans Ages 17-24 years ~1/3 of 17-24 year olds are too overweight to qualify for service 1., Figure produced by Mission: Readiness, Council for a Strong America, Washington, D.C., 2017, available at http://strongnation.org/articles/414- using data from the DoD s Joint Advertising Market Research and Studies analysis of CDC s NHANES. Slide 5 of 13

Civilians exceeding enlistment standards 100 90 80 70 Percent of military-age Americans that exceed service-specific weight-forheight and body fat standards (2008) Percentage 60 50 40 30 20 10 0 16.5m 35% 9.8m 7.7m 6.1m 5.9m 5.7m 21% 3.4m 2.4m 16% 12% 13% 13% 7% 5% Army Navy Air Force Marine Corps Men Women 1. Cawley J. and Maclean J. Unfit for Service: The Implications of Rising Obesity for U.S. Military Recruitment. National Bureau of Economic Research, Cambridge, MA, 2010. Slide 6 of 13

Ineligibility of Military Applicants Approximately 9% of active component enlisted applicants were disqualified due to obesity (based on ICD-9 code). 1 Approximately 16% of active component enlisted applicants were disqualified due to weight, body build (based on other medical failure codes from USMEPCOM). 1 Existing recruitment and accessions standards are not posing challenges to recruitment goals per each Service s Recruit Commands. 2 1. Accession Medical Standards Analysis and Research Activity, 2015 Annual Report. Silver Spring, MD: Walter Reed Army Institute of Research; 2015. 2. Implications of Trends in Obesity and Overweight for the Department of Defense, Defense Health Board, Nov 22, 2013. Slide 7 of 13

Weight status of Army Enlistees Objectives: identify changes in weight status at Army entry from 1989 to 2012, and the demographic characteristics associated with overweight/obesity. Prevalence of exceeding the screening table weights increased with time (5.7% in 1989, 22% in 1992, high of 31% in 2006 and 2007, ~25% in 2012). Demographic predictors (2008-2012): women less likely to exceed the guidelines compared to men. women 20-29 or 30-39 years more likely to exceed guidelines vs. <20 years. 1. Hruby A, Hill T, Bulathsinhala L, McKinnon C, Montain S, Young A, and Smith T. Trends in Overweight and Obesity in Soldiers Entering the U.S. Army, 1989-2012. Obesity, 23(3), 2015. Slide 8 of 13

Weight Status and Injury Risk Objective: examine the association between BMI at accession and lower extremity musculoskeletal injury disorder (MID) during a Soldier s career. ~740K followed from accession into Army during 2001-2011. ~400K cases of MID documented; overall MID rate 2.62 per 100 person-months. 1. Hruby A, Bulathsinhala L, McKinnon C, Hill O, Montain S, Young A, and Smith T. BMI and Lower Extremity Injury in U.S. Army, 2001-2011. Am J Prev Med, 50(6), 2016. Slide 9 of 13

Weight status of Army Enlistees Relative to Soldiers with normal BMI (18.5 to <25 kg/m 2 ) at accession: BMI <18.5 = 7% higher risk BMI 25 to <30 = 11% higher risk BMI >30 = 33% higher risk 1. Hruby A, Bulathsinhala L, McKinnon C, Hill O, Montain S, Young A, and Smith T. BMI and Lower Extremity Injury in U.S. Army, 2001-2011. Am J Prev Med, 50(6), 2016. Slide 10 of 13

Weight Status and Cardiometabolic Risk Objective: examine the association between BMI at accession and incident cardiometabolic risk factors (CRF). Incidence of CRFs: Metabolic syndrome: 228 Soldiers Glucose/insulin disorder: 3,880 Soldiers Hypertension: 26,373 Soldiers Dyslipidemia: 13,404 Soldiers Overweight and obese had significantly higher risk of developing each CRF. 1. Hruby A, Bulathsinhala L, McKinnon C, Hill O, Montain S, Young A, and Smith T. BMI and Lower Extremity Injury in U.S. Army, 2001-2011. Am J Prev Med, 50(6), 2016. Slide 11 of 13

Implications for Recruitment 1. Existing recruitment and accessions standards are appropriate and are not posing challenges to recruitment goals. 2. Recruitment centers should collect info re: individuals who are turned away due to weight status. 3. DoD should assess feasibility of training recruiters to calculate BMI and collect circumference measurements (IAW DoDI 1308.3). 4. Current accession standards should be maintained as minimal requirement for agile and responsive fighting force. 1. Implications of Trends in Obesity and Overweight for the Department of Defense, Defense Health Board, Nov 22, 2013. Slide 12 of 13

Questions? Tracey.Smith10.civ@mail.mil //FOUO Slide 13 of 13